Uterotubal transport abnormal in patients with adenomyosis and endometriosis

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NEW YORK (Reuters Health), Sep 6 - Abnormal uterotubal transport may explain the infertility seen in women with adenomyosis and endometriosis, according to a report in the August BJOG: An International Journal of Obstetrics and Gynecology.

"In patients with endometriosis, more interest should be focused on the uterus, not only on the peritoneal endometriosis," Dr. Stefan Kissler from Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany told Reuters Health.

Dr. Kissler and colleagues examined whether uterotubal transport disorder and impeded sperm transport in 41 women with endometriosis is caused by the endometriosis itself or by the adenomyotic component of the disease.

Twenty-nine of the women had definite signs of adenomyosis on MRI, the investigators found, though only 17 fulfilled the criteria for the diagnosis. Six more women had features suggestive of adenomyosis.

Two-thirds of women without adenomyosis had normal uterotubal transport (as measured by hysterosalpingoscintigraphy (HSSG), the results indicate, compared with only 42% of women with focal adenomyosis and 9% of women with diffuse adenomyosis.

The stage of pelvic endometriosis did not correlated with the extent of adenomyosis, the researchers note.

"Our data strongly suggest that adenomyosis and endometriosis are variants of the same disease with uterine hyperperistalsis and dysperistalsis being of critical importance," the investigators write.

"The probability for a patient showing signs of diffuse adenomyosis in MR imaging and additionally a failure in transport of the sperm-like inert particles in hysterosalpingoscintigraphy (HSSG) for a spontaneous conception is almost excluded," Dr. Kissler said. "These patients should be advised to take part in in vitro fertilization (IVF)."

By Will Boggs, MD

Last Updated: 2006-09-05 15:15:23 -0400 (Reuters Health)

BJOG 2006;113:902-908.

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